An Education Gradient in Health, a Health Gradient in Education, or a Confounded Gradient in Both?

Abstract

There is a positive gradient relating educational attainment and health, yet the causal direction of the gradient is not clear. Does higher education improve health — an education gradient in health? Or do the healthy become highly educated — a health gradient in education? This study evaluates the direction of the gradient by tracking changes in educational attainment and self-rated health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort (NLSY97). Ordinal logistic regression confirms that there is a health gradient in education: that is, high-SRH adolescents are more likely to become highly educated, partly but not entirely because adolescent SRH is associated with adolescents’ academic performance, college plans, and family background. Fixed-effects longitudinal regression shows that, once initial advantages in SRH are controlled, individuals who complete higher levels of education experience little improvement in their SRH. Completion of a high school diploma or associate’s degree has no effect on SRH at age 31, while completion of a bachelors or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is primarily a health gradient in education, not an education gradient in health.

Keywords: education gradient in health, health gradient in education, self-rated health, education, fixed-effects